<?php
/* @var $this ReviewSystemsController */
/* @var $model ReviewSystems */
/* @var $form CActiveForm */
?>

<div class="wide form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'action'=>Yii::app()->createUrl($this->route),
	'method'=>'get',
)); ?>

	<div class="row">
		<?php echo $form->label($model,'id'); ?>
		<?php echo $form->textField($model,'id'); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'fever_weight_loss_or_gain'); ?>
		<?php echo $form->textField($model,'fever_weight_loss_or_gain',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'integumentary'); ?>
		<?php echo $form->textField($model,'integumentary',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'neurological'); ?>
		<?php echo $form->textField($model,'neurological',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'headaches'); ?>
		<?php echo $form->textField($model,'headaches',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'migrains'); ?>
		<?php echo $form->textField($model,'migrains',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'seizures'); ?>
		<?php echo $form->textField($model,'seizures',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'eyes'); ?>
		<?php echo $form->textField($model,'eyes',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'loss_of_vision'); ?>
		<?php echo $form->textField($model,'loss_of_vision',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'distorted_vision'); ?>
		<?php echo $form->textField($model,'distorted_vision',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'loss_side_vision'); ?>
		<?php echo $form->textField($model,'loss_side_vision',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'double_vision'); ?>
		<?php echo $form->textField($model,'double_vision',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'dryness'); ?>
		<?php echo $form->textField($model,'dryness',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'mucousdischarge'); ?>
		<?php echo $form->textField($model,'mucousdischarge',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'redness'); ?>
		<?php echo $form->textField($model,'redness',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'sandy_gritty_feeling'); ?>
		<?php echo $form->textField($model,'sandy_gritty_feeling',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'itching'); ?>
		<?php echo $form->textField($model,'itching',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'burning'); ?>
		<?php echo $form->textField($model,'burning',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'foreign_body_sensation'); ?>
		<?php echo $form->textField($model,'foreign_body_sensation',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'excess_tearing'); ?>
		<?php echo $form->textField($model,'excess_tearing',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'glare'); ?>
		<?php echo $form->textField($model,'glare',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'soreness'); ?>
		<?php echo $form->textField($model,'soreness',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'chronicinfection_on_eyes'); ?>
		<?php echo $form->textField($model,'chronicinfection_on_eyes',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'sties'); ?>
		<?php echo $form->textField($model,'sties',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'Flashes'); ?>
		<?php echo $form->textField($model,'Flashes',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'tiredeyes'); ?>
		<?php echo $form->textField($model,'tiredeyes',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'endocrine'); ?>
		<?php echo $form->textField($model,'endocrine',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'thyroid_othe_rgland'); ?>
		<?php echo $form->textField($model,'thyroid_othe_rgland',array('size'=>5,'maxlength'=>5)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'chief_complains'); ?>
		<?php echo $form->textField($model,'chief_complains',array('size'=>60,'maxlength'=>300)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'medication_taken'); ?>
		<?php echo $form->textField($model,'medication_taken',array('size'=>60,'maxlength'=>300)); ?>
	</div>

	<div class="row">
		<?php echo $form->label($model,'personalinfo_id'); ?>
		<?php echo $form->textField($model,'personalinfo_id'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton('Search'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- search-form -->